Capsular Contracture with Breast Implants in the Cosmetic Patient: Saline versus Silicone–A Systematic Review of the Literature

BACKGROUND: Capsular contracture is one of the most common and trying complications associated with the placement of breast prostheses. The authors hypothesized that silicone implants have a higher rate of capsular contracture than saline implants when used for cosmetic, nonreconstructive breast augmentation. This was based on several previous studies and the experience of the senior author (R.J.R.). The authors objectively evaluated this hypothesis using a systematic review of the literature, specifically examining the incidence of capsular contracture with saline and silicone cosmetic breast implants. METHODS: A review of the PubMed, OVID, and Cochrane databases for prospective studies using these implants and having at least 1-year follow-up on all implants was performed. Reference articles of the articles meeting these inclusion criteria were also included. Two independent reviewers performed the same systematic review with the same a priori criteria, and discrepancies were settled by the senior author. RESULTS: The systematic review was performed in March of 2009. One thousand six hundred ninety-six articles were identified as potentially inclusive based on the search term "breast augmentation." When filtered for "saline or silicone" search terms, 583 articles were found. In the end, 16 articles met inclusion criteria. CONCLUSIONS: There is a lack of current prospective data comparing saline and silicone breast implants in the literature, thereby interfering with the ability of physicians to make data-driven recommendations to patients based on the best medical evidence. The authors were unable to accept or reject their null hypothesis definitively based on this review.